Each program has pros and cons, but the benefit of rigorous egg donor selection processes at IVF centers cannot be overstated
Egg donor agencies vs. egg donor programs at IVF centers
Something dramatic and new has been happening over the last decade: IVF centers in the U.S. have progressively given up on maintaining their own egg donor pools. In the initial stages of this development, the reasons were mostly financial: it is expensive and very time-consuming to screen large numbers of candidates to select only a few, among which, again only very few, will be selected by patients as their egg donors and will go through IVF cycles. In other words, maintaining egg donor pools is usually a money losing proposition for IVF center.
This was recognized not only by IVF centers but also by entrepreneurs, who quickly realized that serving a number of IVF centers and the public, all at the same time, can make the donor selection process a profitable business model. IVF centers, therefore, started closing down their own donor programs or converting them into independent agencies that served multiple IVF centers at once and also offered the public access to their egg donor pools. These developments alone dramatically reduced the number of IVF center-based egg donor pools.
Advantages of frozen donor egg banks
The numbers, however, very quickly fell further with the establishment of frozen donor egg banks. Such banks have opened up all over the U.S. and are gaining quickly in popularity. There are good reasons for their popularity because in many ways egg banks simplify the egg donation process. That is especially true for IVF centers, which now no longer carry the burdens of screening and selecting their own egg donors. They now also can choose the timing of donor egg recipient cycles at their convenience instead of being dependent on the donors’ time schedules and menstrual patterns. Once eggs are frozen, they, of course, can be thawed at any time, even on short notice.
A second advantage of donor egg banks is the expanded donor choice. Because of associated expenses, even large IVF centers usually maintained only small active donor pools. Frequently, that offered little choice to patients who really had to accept what was available when reaching the front of the waiting queue of recipients. With so many frozen egg banks now offering eggs, patients, of course, have considerable choice.
Is frozen donor egg cycles cheaper?
Among the most widely heard arguments in favor of donor egg banks is lower cycle costs. Yet, we are unaware of studies that actually confirm this fact. Indeed, considering the high fees donor egg banks charge for each egg, the cost-effectiveness issue really should be thoroughly investigated before conclusions are reached. Because such an investigation may offer surprising results, industry is, of course, not very interested in pursuing such studies, and CHR, for the time being, remains skeptical about the industry stance that use of frozen donor eggs lowers cycle costs. The process, however, clearly financially benefits IVF centers.
Disadvantages of frozen donor egg banks
Donor egg banks also offer considerable downsides, and those are the principal reasons why CHR has not joined the rush toward utilization of frozen eggs and still continues to maintain its own egg donor pool. Some of CHR’s concerns are data drive, while others are only intuitive though potentially no less important:
- The most important intuitive concern is that donor selection must not suffer. It is, however, difficult to imagine that, once the process is conducted by primarily economically interested parties, corners may not be cut in order to be able to offer largest donor pools. If CHR patients select donors from frozen banks and/or commercial donor agencies, we, therefore, strongly recommend that CHR physicians be allowed to perform review of the donor’s qualification before patients commit to her eggs. At CHR, selection of egg donors is considered not only a crucially important medical step in maximizing IVF chances for patients but also an ethical obligation because donor selection determines the genetic make-up of their future children. Patients who reach the difficult decision of giving up on their own eggs by turning toward egg donation, must be made as secure as possible in their knowledge about who their egg donor is.
- Frozen donor eggs offer significantly lower pregnancy and live birth rates than fresh donor eggs. Though some colleagues may dispute this statement, it nevertheless is absolutely correct. After investigating a national database including most U.S. IVF centers, investigators from CHR published a short communication in the prestigious medical journal JAMA a few years ago that made this point. Some colleagues criticized the study by arguing that the observed difference was only consequence of inexperience of many centers which only recently started working with frozen donor eggs. They further argued that over time the observed difference would disappear. A repeat analysis of national U.S. data by the same investigators a few years later revealed, however, exactly the opposite trend: As increasingly more IVF centers started using frozen donor eggs, the difference to fresh donor eggs only continued to expand and by now exceeds 10% in absolute terms in favor of fresh donor egg.
- Such an outcome difference may be well compensated if the advantages outweigh the disadvantages, but both must be transparently presented to patients, so that they (and not their physicians) can make the right choices for themselves.
This is a part of October 2018 CHR VOICE.